• Psychotic disorders
• Schizophrenia

• Digital health
• Digital mental health
• Feasibility trial
• Illness self-management
• Schizophrenia
• Smartphone application

• Humans
• Schizophrenia/therapy
• Feasibility Studies
• Mobile Applications
• Male
• Female
• Adult
• Telemedicine
• Middle Aged
• Single-Blind Method
• COVID-19
• Smartphone
• Patient Satisfaction
• Digital Health

• adult
• adults
• bipolar disorder
• digital intervention
• digital media
• ecological momentary assessment
• linear mixed model
• media use
• medical center
• mental health
• mental health clinic
• paranoia
• psychiatrist
• psychiatry
• psychosis
• schizoaffective
• schizophrenia
• social media
• sociodemographic
• spectrum
• technology

• Humans
• Female
• Male
• Bipolar Disorder/psychology
• Bipolar Disorder/epidemiology
• Ecological Momentary Assessment
• Adult
• Schizophrenia/epidemiology
• Schizophrenia/diagnosis
• Social Media/statistics & numerical data
• Middle Aged
• Paranoid Disorders/psychology
• Paranoid Disorders/epidemiology

• R01 MH112620 NIMH NIH HHS

• Application development
• Digital health technology
• Sensors

• Humans
• Sleep Initiation and Maintenance Disorders/therapy
• Mobile Applications
• Cognitive Behavioral Therapy/methods
• Schizophrenia/therapy
• Schizophrenia/complications
• Wearable Electronic Devices

• R01 HL157985 NHLBI NIH HHS
• Havens Established Investigator Grant Brain and Behavior Research Foundation
• T32 HL134632 NHLBI NIH HHS
• K23MH119375 NIMH NIH HHS
• T32 HL166127 NHLBI NIH HHS
• R01 HL166485 NHLBI NIH HHS
• R01 AG063925 NIA NIH HHS
• R01 HL154926 NHLBI NIH HHS
• R01 HL148436 NHLBI NIH HHS
• K23 MH119375 NIMH NIH HHS
• National Institute of Mental Health
• American Psychiatric Association
• Veterans Affairs San Diego Healthcare System
• Foundation for the National Institutes of Health

• National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust and the East London NHS Foundation Trust

• Social media
• first episode psychosis
• internet
• schizophrenia spectrum disorders
• social functioning
• young adult

• m-health
• mobile digital tools
• mobile technologies.
• schizophrenia
• social media

• adult psychiatry
• mental health
• psychiatry

• Humans
• Berlin
• Inpatients
• Cross-Sectional Studies
• Digital Technology
• Cell Phone
• Germany/epidemiology

Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings.

We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations.

Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.

• Mental disorder
• Mental health
• Nursing
• Social media

Social media has redesigned the landscape of human interaction, and data obtained through these platforms are promising for schizophrenia diagnosis and management. Recent research shows mounting evidence that machine learning analysis of social media content is capable of not only differentiating schizophrenia patients from healthy controls, but also predicting conversion to psychosis and symptom exacerbations. Novel platforms such as Horyzons show promise for improving social functioning and providing timely access to therapeutic resources. Social media is also a considerable means to assess and lessen the stigma surrounding schizophrenia. Herein, the relevant literature pertaining to social media and its clinical applications in schizophrenia over the past five years are summarized, followed by a discussion centered on user feedback to highlight future directions. Social media provides valuable contributions to a multifaceted digital phenotype that may improve schizophrenia care in the near future.

• Social media
• Schizophrenia
• Digital phenotype
• Facebook
• YouTube
• Instagram

Digital technology, the internet, and social media are increasingly investigated as promising means for monitoring symptoms and delivering mental health treatment. These apps and interventions have demonstrated preliminary acceptability and feasibility, but previous reports suggest that access to technology may still be limited among individuals with psychotic disorders relative to the general population.

We evaluated and compared access to and use of technology and social media in young adults with psychotic disorders (PD), young adults with clinical risk for psychosis (CR), and psychosis-free youths (PF).

Participants were recruited through a coordinated specialty care clinic dedicated toward early psychosis as well as ongoing studies. We surveyed 21 PD, 23 CR, and 15 PF participants regarding access to technology and use of social media, specifically Facebook and Twitter. Statistical analyses were conducted in R. Categorical variables were compared among groups using Fisher exact test, continuous variables were compared using 1-way ANOVA, and multiple linear regressions were used to evaluate for covariates.

Access to technology and social media were similar among PD, CR, and PF participants. Individuals with PD, but not CR, were less likely to post at a weekly or higher frequency compared to PF individuals. We found that decreased active social media posting was unique to psychotic disorders and did not occur with other psychiatric diagnoses or demographic variables. Additionally, variation in age, sex, and White versus non-White race did not affect posting frequency.

For young people with psychosis spectrum disorders, there appears to be no “technology gap” limiting the implementation of digital and mobile health interventions. Active posting to social media was reduced for individuals with psychosis, which may be related to negative symptoms or impairment in social functioning.

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

• Attenuated psychosis syndrome
• COVID-19
• Pandemic
• Prodrome
• Ultra high-risk

• Adolescent
• COVID-19
• Humans
• Internet Use
• Mental Health
• Pandemics
• Psychotic Disorders/epidemiology
• SARS-CoV-2
• Social Media

• Mobile health (mHealth)
• motivation
• schizophrenia
• technology-based intervention
• text-messages

• Instagram
• social media
• social support
• undergraduate and graduate students
• young adult health

• Disclosure
• Humans
• Mental Health
• Social Media
• Students/psychology
• Universities

• relapse prevention
• schizophrenia
• schizoaffective disorder
• mhealth

• Adult
• Female
• Humans
• Male
• Medication Adherence/psychology
• Patient Acceptance of Health Care/psychology
• Pilot Projects
• Psychotic Disorders/diagnosis
• Psychotic Disorders/psychology
• Psychotic Disorders/therapy
• Schizophrenia/diagnosis
• Schizophrenia/therapy
• Secondary Prevention/methods
• Secondary Prevention/trends
• Text Messaging/trends

• R34 MH108781 NIMH NIH HHS

• Digital technology
• Low-income and middle-income countries
• Mental illness
• Stigma

• U19 MH113211 NIMH NIH HHS

• aftercare
• digital
• internet
• mobile
• relapse prevention
• schizophrenia

• Cell Phone
• Continuity of Patient Care
• Feasibility Studies
• Humans
• Internet
• Pilot Projects
• Schizophrenia/therapy

• CBT, cognitive behavioural therapy
• CBTp, cognitive behavioural therapy for psychosis
• Digital mental health
• EMA, ecological momentary assessment
• Engagement
• FEP, first-episode psychosis
• Intervention
• Psychosis
• eHealth

• information-seeking behaviour
• social media
• surveys

The objective of the study was to test the usability of ‘Feeling Master’ as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the ‘Feeling Master’ that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the ‘Feeling Master’ and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the ‘Feeling Master’ could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

• emotion
• facial
• gaming
• recognition
• schizophrenia
• social cognition
• tool

• Conjoint analysis
• Health informatics
• Mental illness
• Patient preferences
• Schizophrenia
• Weight management

• Ambulatory Care Facilities
• Humans
• Patient Preference
• Schizophrenia/therapy

• R21 MH100565 NIMH NIH HHS

• adherence
• app
• e-health
• psychosis
• smartphone

In schizophrenia spectrum populations, adherence to treatment is poor, community-based supports are limited, and efforts to foster illness self-management have had limited success. These challenges contribute to frequent, lengthy, and costly hospital readmissions and poor functional outcomes. Digital health strategies, in turn, hold considerable promise in the effort to address these problems.

This feasibility trial will examine a digital health platform called App4Independence (A4i), which was designed to enhance illness self-management and treatment engagement for individuals with schizophrenia.

Feasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period.

This study was funded by the Canadian Institutes of Health Research in January 2020 and received Institutional Review Board approval on August 13, 2020. This study plans to begin recruiting in January 2021 and will be completed within 3 years. Data collection is projected to begin in January 2021.

This research will provide critical information for the development of this new technology in the larger effort to address a key problem in the schizophrenia field—how to leverage technology to enhance illness self-management and care engagement in resource-limited service contexts.

PRR1-10.2196/24736

• digital health
• mobile health
• psychosis
• schizophrenia
• smartphone

• Chinese
• Intention
• Preferences
• Schizophrenia
• WeChat
• mHealth

• Neuroimaging
• Schizophrenia
• Social punishment
• Social reward
• fMRI

• Brain/diagnostic imaging
• Humans
• Magnetic Resonance Imaging
• Neuroimaging
• Punishment
• Quality of Life
• Reward
• Schizophrenia/diagnostic imaging

The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China.

This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS.

We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching.

The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life.

WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China.

• China
• WeChat
• functioning
• mHealth
• quality of life
• recovery
• schizophrenia
• symptoms
• well-being

• digital health
• mHealth
• mental health
• psychiatry
• safety
• social media

• K23 MH116130 NIMH NIH HHS
• R01 MH110965 NIMH NIH HHS
• U19 MH113211 NIMH NIH HHS

• literature review
• mental illness and addiction
• peer support
• peer support workers
• social support

#selfharm has been blocked by Instagram, but manoeuvring hashtags (e.g. #selfharn) are beginning to appear in order for secret non-suicidal self-injury (NSSI) communities to communicate. The purpose of this study was to (a) determine the nature of the #selfharn conversation on Instagram, (b) analyze common properties of the visual content (i.e. images and videos; n = 93) tagged with #selfharn, and (c) discover what kind of environment the authors (n = 50) of #selfharn were creating.

A multi-method approach was utilized for this study. Netlytic was used to generate a text and content analysis to examine the authors’ captions and comments (n = 8772) associated with #selfharn (collected over a seven-day period).

After removing #selfharn from the dataset, the text analysis revealed that #depression (n = 3081) and #suicide (n = 2270) were the most commonly used terms associated with #selfharn. Overall, 52% (n = 4386) of the popular words/phrases related with #selfharn posts were categorized as ‘bad feelings’. Through manual coding, it was determined that the majority of #selfharn visual content (n = 92; 99%) did not generate an advisory warning but did contain a wound (n = 70; 75%). The #selfharn author analysis suggests that most were women (n = 18; 36%) with a dark-coloured profile aesthetic (n = 37; 74%) determined by an overwhelming amount of grey, black, blue, red, or purple colours.

According to the text and content analyses, #selfharn on Instagram may be contributing negatively to an online community of mental-health issues. More resources should be provided by Instagram to those who are involved in the NSSI Instagram community.

• Instagram
• Netlytic
• Non-suicidal self-injury
• mental health
• well-being

• Mental illness and alcohol/drug abuse
• Psychotic Disorders
• bipolar disorder
• cell phone
• mobile applications
• smartphone

• Clinical high risk
• First episode psychosis
• Information technology
• Social media
• Social support

• computer
• internet
• schizoaffective disorder
• schizophrenia
• smartphone
• technology

• adherence
• antipsychotics
• efficacy
• preference
• schizophrenia
• side effects

• Alkermes, Inc

This study aimed to examine the prevalence of social media use and its association with symptoms in individuals with schizophrenia. 265 individuals with schizophrenia were assessed. Symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). Information on social media use was collected. Logistic regressions were used to explore the association between social media use and socio-demographic and clinical characteristics of the participants. Of the 265 study participants, 139 (52.5%) used social media in the last week. Fifty-six (21.1%) of the study participants used more than one social media site in the last week. Facebook was the most popular social media site. Age, highest education level, monthly household income, PANSS negative and depression factor scores were significantly associated with social media use. Amongst negative symptoms, the CAINS motivation-pleasure (MAP) social factor scores were found to be significantly associated with social media use. Our study results suggested that the assessment of social interactions via social media should be considered in the clinical assessment of individuals with schizophrenia. Secondly, our results suggested that the development of treatment programs supported by social media platforms may be useful for certain groups of individuals with schizophrenia. Younger patients with above secondary level education, higher family income and lower symptom severity are likely to be avid users of social media and would be suitable candidates to receive illness related information or clinical interventions via social media.

• feasibility study
• information system
• internet
• mental health
• patient education
• schizophrenia

• Adult
• Aged
• Feasibility Studies
• Female
• Humans
• Internet
• Male
• Middle Aged
• Non-Randomized Controlled Trials as Topic/methods
• Patient Acceptance of Health Care/statistics & numerical data
• Patient Education as Topic/methods
• Research Design
• Schizophrenia/diagnosis
• Surveys and Questionnaires
• Young Adult

• Adult
• Cell Phone
• Cell Phone Use/statistics & numerical data
• Delivery of Health Care/methods
• Delivery of Health Care/standards
• Female
• Health Services Accessibility/standards
• Health Services Accessibility/statistics & numerical data
• Hospitals, Psychiatric/statistics & numerical data
• Humans
• India/epidemiology
• Male
• Mental Disorders/diagnosis
• Mental Disorders/epidemiology
• Mental Disorders/psychology
• Mental Disorders/therapy
• Mental Health Services/standards
• Mental Health Services/statistics & numerical data
• Outpatients/psychology
• Outpatients/statistics & numerical data
• Qualitative Research
• Quality Improvement

Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations.

• Adolescent
• Adult
• Canada
• Feasibility Studies
• Female
• Humans
• Male
• Medication Adherence
• Mental Health Services/organization & administration
• Middle Aged
• Mobile Applications
• Patient Satisfaction
• Psychotic Disorders
• Research Design
• Schizophrenia/therapy
• Self-Management
• Telemedicine/methods
• Text Messaging
• Urban Health Services/organization & administration
• Young Adult

• Centre for Addiction and Mental Health Foundation

Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health.

This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use.

The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale).

Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type.

The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health–specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life.

• mobile health
• serious mental illness
• smartphone
• social media

• HIV
• breast cancer
• dementia
• diabetes
• psychosis
• public opinion
• social media
• social stigma

• Attitude
• Health Knowledge, Attitudes, Practice
• Humans
• Mental Health/trends
• Social Media/trends
• Social Stigma

Volunteer befriending can be used to address social isolation in patients with psychosis. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely. This study aimed to explore the views and interests of patients with psychosis about different formats of volunteering, face-to-face or digitally.

A survey was conducted with patients with psychotic disorders in community mental health teams in London. Questions covered socio-demographic characteristics, quality of life, loneliness, views on the different formats of volunteering and types of volunteers, and their interest in getting volunteering support, face-to-face or digitally. Binary logistic regressions were used to investigate potential predictors of interest in getting volunteering support face-to-face or digitally.

A total of 151 patients with psychotic disorders were included in this study. More than half of the patients (n = 87, 57.6%) had not heard about these volunteering programs. Many were interested in getting face-to-face (n = 87, 57.6%) and digital (n = 56, 37.1%) volunteering. For the face-to-face encounters, most preferred them to be weekly (n = 36, 41.4%), for one-hour (n = 32, 36.8%), and with an open-ended relationship (n = 45, 51.7%). For the digital contacts, most preferred them to be weekly (n = 17, 30.9%) and through text messages (n = 26, 46.4%). A minority of patients (n = 20, 13.2%) did not use digital technology. Patients with lower quality of life were significantly more likely to prefer face-to-face volunteering (p < .05). Younger patients and with fewer years of diagnosis were significantly more likely to prefer digital volunteering (p < .05).

The variability in patients’ interests suggests that different formats of volunteer support should be offered. Digital volunteering may become more important in the future, since many younger patients are interested in it.

• Adult
• Aged
• Female
• Friends
• Humans
• Internet
• London
• Loneliness
• Male
• Middle Aged
• Patient Preference
• Psychotic Disorders/rehabilitation
• Quality of Life
• Regression Analysis
• Social Behavior
• Social Class
• Social Isolation/psychology
• Surveys and Questionnaires
• Text Messaging
• Treatment Outcome
• Volunteers
• Young Adult

• RP-PG-0611-20002 Department of Health
• National Institute for Health Research